Patient profile H.G., a 34-year-old female aerobics

Patient profile H.G., a 34-year-old female aerobics instructor, comes to the healthcare provider’s office with concerns about weight gain, amenorrhea, insomnia, changes in her skin, and depression that have occurred in the past 3 months. She informs the nurse that she has been unable to teach aerobics because of weakness, low back pain, and embarrassment about the way she looks. She states that she has multiple bruises for no apparent reason and has facial acne for the first time in her life. She has frequently waxed her upper lip and chin to remove excessive hair. When asked about her diet, she says she has no appetite because “eating makes me sick.” Physical assessment: Vital signs = temperature 99.6° F (37.5° C), blood pressure (BP) 150/82, pulse 90 beats/minute, respiratory rate 22 breaths/minute. A moon face, acne on her forehead, and hyperpigmentation on both cheeks. Her skin is thin, and she has multiple bruises on various areas of her body. Hirsutism is present on her upper lip and chin. Truncal obesity and striae over the abdomen are noted, along with thin peripheral extremities. She has 2+ pitting edema of the anterior aspect of her lower legs. It is suspected that H.G. has Cushing syndrome, and the health care provider schedules her for laboratory testing, including blood work for hematology and chemistries, a urinalysis; and a 24-hour urine test for urinary calcium & free cortisol. Discussion Questions Explain the pathophysiology and etiology (cause) of Cushing syndrome. What symptoms in H.G.’s data suggest Cushing syndrome What is the relationship between Cushing’s syndrome and H.G.’s risk for infection? What electrolyte changes would you expect from H.G.’s laboratory data? What mood disturbances and mental illness are common in patients with Cushing syndrome How is Cushing syndrome treated What are the priority nursing interventions and patient teachings for H.G.? How does prolonged administration of corticosteroids contribute to Cushing syndrome? What interventions will be implemented to address this Explain the importance of avoiding stress before & after adrenalectomy.

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